Dyah Kurniasari Maria, Karwur Ferry Fredy, Rayanti Rosiana Eva, Huruta Andrian Dolfriandra, Lin Yu Huei, Weng Shuen Fu, Tsai Hsiu Ting
School of Nursing, College of Nursing, Taipei Medical University, Republic of China.
Faculty of Medicine and Health Sciences, Department of Nursing, Universitas Kristen Satya Wacana, Salatiga City, Indonesia.
Biol Res Nurs. 2022 Jan;24(1):40-47. doi: 10.1177/10998004211029044. Epub 2021 Aug 3.
Most Indonesians with hyperuricemia are less than 40 years old, which suggests an increasing gout risk in the country. Meanwhile, untreated hyperuricemia was also suggested to lead to hypertension. Yet, it is unclear whether blood pressure (BP) plays a mediating role between urate and gout.
We investigated the mediating effect of BP between urate and gout risk in Indonesians using a partial least squares-structural equation model.
A community-based retrospective case-control study was conducted between July 1 and August 31, 2019 in Indonesia. We randomly recruited 397 participants, including 86 patients with gout and 311 healthy controls from seven community health service centers. Multivariate logistic regression was employed to analyze the adjusted odds ratios of the association between risk factors, such as urate level and BP, and gout risk after controlling for other covariates. A path analysis was utilized to analyze the mediating effect of systolic BP between urate and gout. The STROBE reporting guideline for the observational study is adopted in our reporting.
We found that a 1 mg/dL increase of urate level significantly increased gout risk with an OR of 4.97 (95% CI: 3.48-7.09) and an AOR of 4.44 (95% CI: 3.076.42) after adjusting for covariates. The association between urate and gout was also significantly mediated by systolic BP (β = 0.05; 95% CI Bias Corrected [0.02-0.08], < 0.001).
Urate was significantly associated with gout risk and was possibly mediated by increased systolic BP in Indonesians. Controlling systolic BP could be one of the strategies to decrease the risk of gout for individuals with hyperuricemia. Health education can be carried out by community health nurses to individuals on controlling their urate level and systolic BP to decrease the gout risk among Indonesian.
大多数印度尼西亚高尿酸血症患者年龄小于40岁，这表明该国痛风风险在增加。同时，也有研究表明未经治疗的高尿酸血症会导致高血压。然而，尚不清楚血压（BP）在尿酸盐与痛风之间是否起中介作用。
我们使用偏最小二乘结构方程模型研究血压在印度尼西亚人尿酸盐与痛风风险之间的中介作用。
2019年7月1日至8月31日在印度尼西亚进行了一项基于社区的回顾性病例对照研究。我们从七个社区卫生服务中心随机招募了397名参与者，包括86名痛风患者和311名健康对照。采用多因素logistic回归分析尿酸水平和血压等危险因素与痛风风险之间的关联，并在控制其他协变量后分析调整后的优势比。利用路径分析来分析收缩压在尿酸盐与痛风之间的中介作用。我们的报告采用观察性研究的STROBE报告指南。
我们发现尿酸水平每升高1mg/dL，痛风风险显著增加，调整协变量后，OR为4.97（95%CI：3.48-7.09），AOR为4.44（95%CI：3.07-6.42）。收缩压也显著介导了尿酸盐与痛风之间的关联（β=0.05；95%CI偏差校正[0.02-0.08]，P<0.001）。
在印度尼西亚人中，尿酸盐与痛风风险显著相关，可能通过收缩压升高介导。控制收缩压可能是降低高尿酸血症患者痛风风险的策略之一。社区卫生护士可以对个体进行健康教育，以控制尿酸水平和收缩压，从而降低印度尼西亚人的痛风风险。
